François-Pierrick Desgranges1, Olivier Desebbe2, Edmundo Pereira de Souza Neto3,4,5, Darren Raphael6, Dominique Chassard1. 1. Department of Pediatric Anesthesia and Intensive Care Medicine, Femme Mère Enfant Teaching Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France. 2. Department of Anesthesia and Intensive Care Medicine, Sauvegarde Clinic, Claude Bernard Lyon 1 University, EA4169, SFR Lyon-Est Santé - INSERM US 7- CNRS UMS 3453, Lyon, France. 3. Department of Anesthesia, Montauban Hospital, Montauban, France. 4. Laboratory of Physics, Ecole Normale Supérieure de Lyon, Lyon, France. 5. Oeste Paulista University (UNOESTE), Presidente Prudente, São Paulo, Brasil. 6. Department of Anesthesia and Perioperative Care, School of Medicine, University of California Irvine, Orange, CA, USA.
Abstract
BACKGROUND: Dynamic indices of preload have been shown to better predict fluid responsiveness than static variables in mechanically ventilated adults. In children, dynamic predictors of fluid responsiveness have not yet been extensively studied. AIM: To evaluate the diagnostic accuracy of respiratory variation in aortic blood flow peak velocity (ΔVPeak) for the prediction of fluid responsiveness in mechanically ventilated children. METHOD: PubMed, Embase, and the Cochrane Database of Systematic Reviews were screened for studies relevant to the use of ΔVPeak to predict fluid responsiveness in children receiving mechanical ventilation. Clinical trials published as full-text articles in indexed journals without language restriction were included. We calculated the pooled values of sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio using a random-effects model. RESULTS: In total, six studies (163 participants) met the inclusion criteria. Data are reported as point estimate with 95% confidence interval. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of ΔVPeak to predict fluid responsiveness for the overall population were 92.0% (84.1-96.7), 85.5% (75.6-92.5), 4.89 (2.92-8.18), 0.13 (0.07-0.25), and 50.44 (17.70-143.74), respectively. The area under the summary receiver operating characteristic curve was 0.94. Cutoff values for ΔVPeak to predict fluid responsiveness varied across studies, ranging from 7% to 20%. CONCLUSION: Our results confirm that the ΔVPeak is an accurate predictor of fluid responsiveness in children under mechanical ventilation. However, the question of the optimal cutoff value of ΔVPeak to predict fluid responsiveness remains uncertain, as there are important variations between original publications, and needs to be resolved in further studies. The potential impact of intraoperative cardiac output optimization using goal-directed fluid therapy based on ΔVPeak on the perioperative outcome in the pediatric population should be subsequently evaluated.
BACKGROUND: Dynamic indices of preload have been shown to better predict fluid responsiveness than static variables in mechanically ventilated adults. In children, dynamic predictors of fluid responsiveness have not yet been extensively studied. AIM: To evaluate the diagnostic accuracy of respiratory variation in aortic blood flow peak velocity (ΔVPeak) for the prediction of fluid responsiveness in mechanically ventilated children. METHOD: PubMed, Embase, and the Cochrane Database of Systematic Reviews were screened for studies relevant to the use of ΔVPeak to predict fluid responsiveness in children receiving mechanical ventilation. Clinical trials published as full-text articles in indexed journals without language restriction were included. We calculated the pooled values of sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio using a random-effects model. RESULTS: In total, six studies (163 participants) met the inclusion criteria. Data are reported as point estimate with 95% confidence interval. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of ΔVPeak to predict fluid responsiveness for the overall population were 92.0% (84.1-96.7), 85.5% (75.6-92.5), 4.89 (2.92-8.18), 0.13 (0.07-0.25), and 50.44 (17.70-143.74), respectively. The area under the summary receiver operating characteristic curve was 0.94. Cutoff values for ΔVPeak to predict fluid responsiveness varied across studies, ranging from 7% to 20%. CONCLUSION: Our results confirm that the ΔVPeak is an accurate predictor of fluid responsiveness in children under mechanical ventilation. However, the question of the optimal cutoff value of ΔVPeak to predict fluid responsiveness remains uncertain, as there are important variations between original publications, and needs to be resolved in further studies. The potential impact of intraoperative cardiac output optimization using goal-directed fluid therapy based on ΔVPeak on the perioperative outcome in the pediatric population should be subsequently evaluated.
Authors: Kavita G Morparia; Srijaya K Reddy; Laura J Olivieri; Michael C Spaeder; Jennifer J Schuette Journal: J Clin Monit Comput Date: 2017-03-16 Impact factor: 2.502
Authors: Willem P de Boode; Robin van der Lee; Beate Horsberg Eriksen; Eirik Nestaas; Eugene Dempsey; Yogen Singh; Topun Austin; Afif El-Khuffash Journal: Pediatr Res Date: 2018-07 Impact factor: 3.756